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Applicant
Location of Contravention
Date of Contravention
You must ensure that all details above are correctly entered from the form TE3 - Order for Recovery of
unpaid penalty charge (Parking).
Title
Mr.
Full name
(Respondent)
Address
Mrs
Miss
Other
Ms.
Postcode
The above named witness, declares that: Tick all boxes that apply to you.
Note: If your penalty charge relates to a London Borough Parking Contravention tick only ONE box
Proceedings for contempt of court may be brought against you if you make or cause to be made
a false statement in an application verified by a statement of truth without an honest belief in its
truth.
Statement of truth
(I believe) (The witness believes) that the facts stated in this application are true.
Signed
Date
Note: If your penalty charge relates to a London Borough Parking Contravention you may make a
witness statement under ONE of the following grounds
You paid the penalty charge notice in full. You must provide details of the date payment was made,
the method of payment i.e. cash, cheque etc and who the payment was made to. Please note you
may be asked to provide proof of payment upon request.
You did not receive the notice to owner/penalty charge notice.
You made representations about the penalty charge notice to the Local Authority within 28 days of
service of the notice to owner but did not receive a reply (rejection notice).
You appealed against the Local Authoritys decision to reject your representation within 28 days, but
you had no response to your appeal.
Proceedings for contempt of court may be brought against you if you make or cause to be made
a false statement in a witness statement verified by a statement of truth without an honest belief
in its truth
You must file the witness statement by the date shown on the Order for recovery.
Once completed send to the Traffic Enforcement Centre at
County Court Business Centre
St Katharines House,
21 27 St Katharines Street
Northampton
NN1 2LH
or tec@hmcts.gsi.gov.uk